Broomy Hill Nursing Home

Broomy Hill Nursing Home is a residential care home providing personal and nursing care to up to 40 people. The service provides support to older people who may live with dementia or mental health support needs. At the time of our inspection there were 37 people using the service. Broomy Hill Nursing Home accommodates people in one adapted building.

People’s experience of using this service and what we found

The registered manager and senior staff had made improvements to the way people’s medication and risks were managed. This helped to ensure people had he medicines they needed to remain well and free of pain and risks to their safety were reduced. There was enough staff to care for people, who had developed the skill required to meet people’s needs. Staff’s competency to provide care to people was checked. Learning was taken from any incidents or errors.

People were now supported by staff to receive the care they need to maintain good skin health. Staff at Broomy Hill Nursing Home worked with other health and social care providers so people’s health needs were promptly met. The registered manager planned to ensure people’s records of repositioning and fluid intake were centrally recorded, so they could be assured people’s health was further promoted. The provider had made significant improvements to the premises, for people to enjoy and they planned more refurbishment. The provider now obtained the views of relatives and external professionals when people’s care needs were assessed and as their needs changed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider regularly checked people received safe care through reviewing electronic care records and visits to the home. The registered manager and senior staff spent time checking people received the care they wanted, and to assure themselves this was done safely. Where actions had been identified these were addressed. The registered manager and senior staff supported staff to understand what was expected of them. Staff now had access throughout the home to guidance they needed on people’s electronic care plans. Relatives, other health and social care professionals and staff told us senior staff were visible in the home and suggestions for developing people's care further were welcomed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 February 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve. At this inspection enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 13 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Broomy Hill Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Broomy Hill Nursing Home is a residential care home providing personal and nursing care for up to 40 people aged 65 and over, some of whom may live with dementia or mental health support needs. At the time of the inspection 25 people were living at the home.

The home has several communal areas including a garden and dining facilities. At the time of the inspection some refurbishment had been completed. Refurbishment was on-going in other areas of the home.

People’s experience of using this service and what we found

People were not always supported to have their medicines as prescribed. This increased the risk people would not have the medicines they needed to remain well. There continued to be no record of daily checks to confirm people’s pain medicine patches remained in place. This increased the risk people may experience pain.

People’s risks and care needs had not consistently been identified and their risks managed. This included in relation to people’s skin health and risk of choking. The provider’s representative agreed to review how they deployed staff at busy times, so people did not experience delays if they required support and encouragement at mealtimes.

Key areas of the premises required the completion of refurbishment, to ensure the likelihood of the spread of infection was reduced and to ensure effective fire management practice. Lack of effective staff and provider oversight of incidents such as medication errors reduced the likelihood of learning lessons when things went wrong.

Risks to people’s health had not been consistently identified and action had not always been promptly taken to advocate with external health professionals so people would get the care they needed. The introduction of a robust system for monitoring peoples nutritional and hydration needs was required to ensure people consistently achieved good health outcomes.

People were not always supported by staff who had received training relevant to their needs, and the provider could not be sure staff had the competency required to support people to have their medicines safely.

The views of external professionals were not always promptly obtained when decisions were taken in people’s best interests. This increased the risk people’s rights would not be respected. Systems for communicating information about conditions on people’s DoLS authorisations was not readily available to the manager, or to guide staff to promote people’s rights.

The provider had failed to ensure there was adequate oversight of the care provided at the home. Quality assurance processes had not fully addressed previous breaches and had not identified concerns we found during this inspection. At this inspection we found the service failed to display the most recent CQC inspection rating at the home.

Systems which the provider had recently introduced did not always provide staff with a full overview of the needs, risks and care people required. The provider had not put robust systems in place to ensure staff roles and responsibilities were consistently clear or to maximise opportunities for developing people’s care further. A new manager had recently been appointed at the home. They told us they intended to apply to CQC to become the registered manager. Changes to the staff representing the provider were also planned.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 19 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 April 2021 and 21 April 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and Well-led which contain those requirements.

We had also received concerns in relation to people’s safety, staffing and governance.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Broomy Hill Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how people’s safety and risks are managed and how the home is managed at this inspection.

Please refer to the end of this report for our full regulatory action taken.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Broomy Hill Nursing Home is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection, some of whom may live with dementia or mental health support needs. The service can support up to 40 people.

The home has several communal areas including a garden and dining facilities. At the time of the inspection the home was being refurbished.

People’s experience of using this service and what we found

We found no evidence people had been harmed but identified systems and practice did not always ensure risks in relation to people’s medicines were reduced. People’s medicines were not always stored in a way which promoted good medicine management, including in relation to temperature checks. Information was not consistently to hand to support staff were to provide medicines safely. There was no record of daily checks to confirm people’s pain medicine patches remained in place.

People’s risks had been identified, however, in some instances actions had not been taken to address these. This increased the risk people would not receive the care they needed, and lessons would not be learned.

Staff knew what action to take if they had any concerns for people’s safety. There were enough staff to care for people and staff were supported to promote good infection control.

Roles and responsibilities were not always clear. This had contributed to a delay in a current fire risk assessment being put in place, and improvements identified as required being driven through. The provider had introduced new governance checks in October 2020. These will require further time to embed effectively, for example in relation to the safe management of medicines and storage of other items. Further development of systems to ensure all incidents and concerns are promptly escalated to the registered manager and provider is required.

People were not always supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Decisions taken on a temporary basis in people’s best interest in respect of the administration of covert medicines were not always promptly referred to other professionals. This increased the risk people’s rights would not be respected. The registered manager and provider’s representative gave us assurances they would address this. In other instances, relatives and other professionals had been consulted about people’s mental capacity assessment and involved in best interests meetings.

Further development of people’s assessments was required in order to ensure people's mental and physical health needs were consistently identified and to ensure people consistently enjoyed good health outcomes. People were not consistently supported to maintain a healthy weight.

Staff supported people to have enough to drink and to attend hospital appointments.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 06 June 2019).

Why we inspected

We received concerns in relation to the safety and management of people’s care needs. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how risks to people’s safety are managed and how the service is led at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Broomy Hill Nursing Home is a residential care home providing personal and nursing care for up to 40 people in a large adapted building. It specialises in supporting people who are living with dementia or who have mental health needs. At the time of our inspection, there were 33 people living at the home.

People’s experience of using this service and what we found

Staff understood how to identify and report any abuse involving the people who lived at the home. The risks associated with people’s care needs had been assessed, and plans were in place to manage these. A more robust and accurate system was needed for recording and monitoring the administration of people’s topical medicines. The provider followed safe recruitment procedures. The provider had taken steps to protect people from the risk of infections.

People’s individual needs were assessed prior to them moving into the home. Staff received ongoing training and support to help them fulfil their duties. People had enough to eat and drink and any associated risks were managed. Staff and management worked with community health and social care professionals to achieve positive outcomes for people. Some steps had been taken to adapt the home’s environment to the needs of people living with dementia. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Formal mental capacity assessments and best-interests decision records were not always clearly recorded.

Staff adopted a caring approach towards their work, and provided prompt support to anyone in distress. People and their relatives were supported to express their views about the service. Staff treated people with dignity and respect, and protected their confidential information.

People’s care plans were individual to them. Procedures for reviewing and updating people’s care plans needed to be improved to make it easier to establish their current needs. People had support to participate in a range of social and recreational activities. People’s relatives knew how to raise any concerns or complaints about the service. People’s wishes and choices about their end of life care were assessed.

The registered manager promoted an open culture within the service. People’s relatives felt able to express their views to the management team. Staff felt supported in their roles and were clear what was expected of them at work. The provider had quality assurance systems and processes in place designed to enable them to monitor and improve the quality of people’s care. The management team sought to involve people, their relatives and staff in the service.

Rating at last inspection

The last rating for this service was Requires improvement (published 9 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Broomy Hill Nursing Home is a ‘care home’. People in care homes received accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Broomy Hill Nursing Home accommodates up to 40 people with dementia-related illness and mental health needs. There were 37 people living at the home when we visited.

There was no registered manager in post during our inspection. We met with the manager who had applied to become registered manager of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection of the service on 16 January 2017, we found a breach of Regulation 17 of the Health and Social Care 2008 (Regulated Activities).Regulations 2014. We gave the service an overall rating of Requires Improvement. This breach related to the ineffectiveness of the provider’s quality assurance. The provider sent us an action plan setting out the improvements they intended to make, and we met with them to discuss this further.

At this inspection, we found the provider was still not meeting the requirements of Regulation 17. Their quality assurance systems and procedures had not enabled them to effectively identify and address the shortfalls in quality we identified during our inspection. We also identified a breach of Regulations 12 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. This related to the provider’s failure to assess and take all reasonable steps to reduce the risks associated with people’s individual care and support needs.

Infection prevention and control measures at the home needed to be improved to more fully protect people and others from the risk of infection. People’s rights under the Mental Capacity Act had not been fully promoted. Staff lacked insight into people’s dietary needs. Care plans were not routinely read by staff and were not always updated in response to people’s changing needs. A more proactive and consistent approach towards advance care planning was needed.

Staff had training in, and understood, their individual responsibility to protect people from abuse, and the provider had procedures in place to ensure any witnessed or suspected abuse was reported to the appropriate external agencies. Staffing levels at the home ensured people’s individual needs could be met safely. The provider completed checks to confirm the suitability of all prospective staff. People received their medicines safely and as prescribed from qualified nurses.

People had support and encouragement to follow a balanced diet, and were involved in choices about what they ate and drank. Any risks associated with people’s eating and drinking were assessed. Staff received training and ongoing support to help them succeed in their roles. They defused difficult situations with skill and insight into people’s individual needs and personalities. Staff and management helped people to access, a range of healthcare services to ensure their health needs were met. The overall design and adaptation of the premises enabled staff to meet the needs of people living with dementia effectively.

Staff adopted a kind and caring approach towards their work. People and their relatives had support to support to participate in decision-making that affected them and to express their views on the service. Staff treated people with dignity and respect.

People received care and support that reflected their individual needs and preferences. People’s relatives were able to contribute towards care planning and care review meetings. People’s care plans were individual to them and covered a range of needs. People had access to a range of social and recreational activities, led by the home’s activities coordinators. People’s relatives knew how to raise any concerns or complaints with the provider.

The management team promoted a positive and inclusive culture within the service, Staff felt well supported and able to request additional support and guidance from the management team. The provider took steps to involve people, their relatives and staff in the service.

Following our inspection on 16 January 2017, we also received concerns in relation to the practice of locking people’s bedroom doors at the home throughout the day and night, and how this was being managed. These doors were fitted with specially designed locks that automatically disengaged when opened from within the bedroom itself. We also looked into these concerns during this focused inspection.

This report only covers our findings in relation to these requirements and concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broomy Hill Nursing Home on our website at www.cqc.org.uk.

This inspection took place on 20 July 2017 and was unannounced.

Broomy Hill Nursing Home provides accommodation with nursing and personal care to a maximum of 40 people living with dementia and mental health needs. There were 36 people living at the home when we visited.

A registered manager was in post and present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had not delivered training to support staff in carrying out their duties and responsibilities, in accordance with the their mandatory training requirements.

The provider conducted staff supervisions more frequently, and these were now being monitored more closely by the management team. The provider had commenced staff members’ annual appraisals.

The provider’s quality assurance activities had been developed and a new annual audit planner introduced. However, the provider's quality assurance was not as effective as it needed to be in enabling them to address concerns and shortfalls in quality in a timely manner to drive improvement.

People’s rights under the Mental Capacity Act 2005 had not been fully protected in the context of the decisions taken to lock most people’s bedroom doors throughout the day and night. Concerns raised with the provider in relation to staff being unable to access, and support people to access, bedrooms without unnecessary delay had not been satisfactorily addressed.

You can see what action we told the provider to take at the back of the full version of the report.

Broomy Hill Nursing Home provides accommodation with nursing and personal care to a maximum of 40 people with dementia-related illness and mental health needs. There were 35 people living at the home when we visited.

A registered manager was in post and present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection on 10 and 12 August 2016, we found breaches of Regulations of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulation 2009. We gave the service an overall rating of requires improvement. These breaches related to the provider's failure to always treat people with dignity and respect, manage people’s medicines safely and notify us of an allegation of abuse involving a person who lived at the home. The provider sent us an action plan setting out the improvements they intended to make.

At this inspection, we found the provider had made some improvements to the service. However, people were still not always treated with dignity and respect. In addition, staff had not received appropriate training, supervision and appraisal. Some staff also still lacked confidence in the registered manager’s ability to act on things brought to their attention. The provider’s quality assurance systems had still not enabled them to address significant shortfalls in the quality of the service.

Staff understood how to recognise and report abuse. The risks associated with people’s care and support needs had been assessed, recorded and plans implemented to manage these. There were sufficient numbers of staff to safely meet people’s needs, although staff deployment could be improved. People’s medicines were managed and administered in a safe manner.

Staff sought people’s consent to care and protected their rights under the Mental Capacity Act 2005 (MCA). Staff supported people to have enough to eat and drink, and to have a balanced diet. People’s day-to-day health needs were met, and staff supported them to access healthcare services.

Staff took a patient, caring and compassionate approach to their work with people. They encouraged people to express their views and be involved in decisions, where possible. People’s care and support was shaped around their individual needs. Staff supported people to spend time doing things they enjoyed and found interesting. People’s relatives knew how to complain about the service, and felt confident their concerns would be appropriately handled. The provider encouraged a positive and open dialogue with people’s relatives. Staff found the management team approachable.

Broomy Hill Nursing Home provides accommodation with nursing and personal care for up to 40 people with dementia-related illness and mental health needs. There were 39 people living at the home when we visited.

A registered manager was in post and present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Working practices at the home needed to be improved to ensure that people received their medicines safely. People were protected by staff that recognised the potential signs of abuse and how to report it. The provider had developed procedures for dealing with any such allegations of abuse, and plans were in place to manage the risks associated with people’s individual care and support needs. The registered manager monitored any incidents and accidents involving people to minimise the risk of reoccurrence. Staffing requirements were assessed and planned, and all new staff underwent appropriate pre-employment checks.

The provider was not always working in accordance with, and respecting people's rights under, the Mental Capacity Act 2005. Staff participated in an ongoing programme of training and received regular one-to-one sessions with the management team. People received the support they needed with eating and drinking, and any associated risks were managed. Staff supported people to maintain their health and sought appropriate professional medical advice and treatment as necessary.

People were not always treated with dignity and respect, and their choice and control over their lives was not always fully supported. Staff knew people’s individual needs well, and supported them to spend time doing things they enjoyed and found interesting. People’s relatives knew how to raise concerns, and felt confident they would be listened to. Not all staff were confident that concerns brought to the attention of the registered manager, about the care and support people received, would be acted upon.

The provider had developed quality assurance systems and checks, however these had not identified significant shortfalls in the service.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. We spent time talking to people and observed the support they received. We talked with visiting relatives, a GP and two other visiting professionals.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Systems were in place to monitor and maintain safety. Records showed that regular safety checks and were undertaken. Staff told us that environmental checks were carried out and any maintenance issues identified were dealt with promptly.

The provider had taken all reasonable steps to help protect people from the risk of abuse. The recruitment process was effective and took necessary action to prevent unsuitable people from working with vulnerable adults.

Staff told us they felt they had been given the necessary training and guidance to carry out their role safely. Risks to people had been identified, assessed and kept under review. This helped maintain people's safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had been trained to understand when an application should be made and how to submit one. Applications had been made appropriately and proper policies and procedures were in place.

Is the service effective?

Appropriate arrangements were in place to support people with limited mental capacity to make decisions that were in their best interest. Two health and social care professionals told us they had been impressed that a mental capacity assessment and record of best interest decisions had already been completed for a person had only moved in that week.

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. The care plans seen had been updated regularly and contained a good level of detail including people's wishes and preferences. Staff had a very good knowledge of people's support needs. Staff aimed to provide a personalised service and felt they had time to meet people's needs.

Incidents and accidents were monitored to look for trends across the service and for the individuals as well. The use of bedrails had been stopped and replaced with less restrictive ways of supporting people. The service aimed to reduce people's anti-psychotic and sedative medicines wherever possible, in liaison with people's representatives and health professionals.

Staff told us that they felt part of a good team and that they were well supported. Their training needs had been assessed and planned for and their performance monitored.

Is the service caring?

The people who were able to give us their views told us that staff were respectful and caring. They told us that they were happy with the care and treatment provided and they had no complaints. We observed staff treating people with dignity and respect. Interactions with people were supportive and kind. We observed people being given choice and encouragement.

We saw that staff responded quickly to people who called for assistance. When one person's knee was painful staff took time to go and check when they could have their next dose of painkillers and explain this to the person with reassurances.

The registered manager and several staff went to the funeral of a person who had lived at the home. They had wanted several staff to attend because they knew there was not any family to attend.

We saw many examples during the day of staff seeking people's consent before they provided them with care and support. Information was given clearly and staff gave people time to digest this and did not rush them.

Is the service responsive?

Visiting professionals told us that the home was successfully supporting people with very complex needs, any concerns had been discussed openly and new people were given time to settle in however challenging their behaviours seemed initially. They had found that requests for medical or psychiatric support were made appropriately. One said, 'The care is personalised' and 'They think outside the box'.

The environment was attractive and had been decorated to be as helpful as possible for people living with dementia. The registered manager told us they always looking for ideas that would improve the environment and experience for those living in the home.

The home's vehicle was used to assist relatives to visit their loved ones and to bring people to the home when they used the respite care service. One relative told us this had been a great help to them since they stopped driving.

Improvements had been quickly made after our inspection in February 2014 when shortfalls were found in staff recruitment practices and arrangements for obtaining people's consent to care and treatment.

Is the service well led?

We saw that the service was being appropriately managed. The provider and registered manager had responded to the shortfalls found at the inspection in February 2014 and had made the improvements needed.

Visiting professionals told us that the home was run well and the staff were pleasant and helpful. They found the clinical lead nurse was very competent and was always well prepared for the many meetings they held. They were always provided with accurate records to assist their reviewing process. The G.P. had no concerns about the nursing care provided.

Staff felt the service was well managed and that their views and ideas were valued. They told us there was enough staff on duty to meet people's needs and no agency staff were used. One carer said, 'We all work together' and 'Everyone supported each other when there were incidents and difficult days'.

The registered manager was aware of their duty to report certain incidents to us, such as deaths, and safeguarding alerts to us and the local authority. Any complaints were recorded and monitored by the provider.

The quality of service provided by the home was regularly monitored and surveys were used to seek people's views.

The care records contained information about people's care needs. The staff reviewed and audited these regularly. The staff told us they had the information they needed to provide the correct care to each person and could describe people's needs when we asked. The arrangements for making sure that consent for care and treatment was obtained in line with legislation needed to be improved.

People's medicines were stored securely and managed in a well organised and safe way.

The staff recruitment procedures needed to be improved to make sure that all the required information was obtained for every applicant.

There were arrangements in place for monitoring the quality of the service and obtaining people's views about the care provided. We saw that the service had received generally positive feedback. We saw comments by several relatives and professionals commending the staff team for their care.

The care records contained information about people's care needs and showed that the staff arranged the health care people needed. Most of the care practice we saw was safe and considerate. We saw examples of care workers supporting people who were distressed. They did this in a sensitive and patient way. We saw two incidents where staff used an incorrect method to move people. We also saw an incident where a care worker moved a person without speaking to them.

We saw that although staff did their best to attend to people as soon as they could, there were occasions when this was delayed. This appeared to be due to staff sickness on the day of our inspection. Staff told us there were normally more staff on duty. One relative told us there was, 'always someone there' when they needed staff to assist their family member.

There was information available for people about how to make a complaint. People told us they would be able to raise anything they weren't happy with.